Reconceptualizing Aplastic Anemia-Seed, Worm, Soil

Aplastic anemia (AA) encompasses a group of hematological syndromes often misdiagnosed, resulting in a decrease in the overall blood cell count and representing a form of bone marrow failure. The disease is defined by damage to hematopoietic stem cells due to various physical, chemical, and biological factors. The diagnosis of the disease is based on clinical presentation, as the underlying etiology remains poorly understood, which complicates treatment options. Understanding bone marrow failure disorders began with cytomorphological studies, which led to the identification of AA syndrome based on the shared characteristics of pancytopenia and bone marrow failure. However, the pathological mechanisms underlying these conditions remain complex and confusing. A comprehensive analysis of biological characteristics, clinical regression, and therapeutic responses was subsequently conducted. This multifaceted approach employed various diagnostic techniques, including immunology, histochemistry, molecular genetics, and second-generation sequencing, to progressively elucidate the underlying syndrome of AA and clarify the disease classification. Consequently, there is a pressing need to adopt a new conceptual framework for understanding AA.

To clarify the definition, characteristics, diagnostic basis and existing problems of AA, and to put forward the necessity of establishing a new conceptual framework for understanding AA.

This review reinterpret AA based on the "seed, worm, and soil" doctrine.

Research advancements have gradually clarified the mechanistic understanding of AA. The disease has evolved from a "hybrid" entity, characterized by disparate elements, to a more analytically recognized condition. We anticipate comprehensive investigations into its characteristics, ultimately enhancing treatment efficacy through precision medicine.